Indian Country Today Media Network.com - Medicaidhttp://indiancountrytodaymedianetwork.com/tags/medicaid
enHouse Budget Promises New Cuts, No Obamacare, And More Defense Dollarshttp://indiancountrytodaymedianetwork.com/2015/03/20/house-budget-promises-new-cuts-no-obamacare-and-more-defense-dollars-159668
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The House Budget Committee unveiled its budget Tuesday — and the details are not good news for Indian country.</p>
</div></div></div>Fri, 20 Mar 2015 13:00:00 +0000kpolisse159668 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2015/03/20/house-budget-promises-new-cuts-no-obamacare-and-more-defense-dollars-159668#commentsNew Twists and Turns In the Soap Opera Called ObamaCarehttp://indiancountrytodaymedianetwork.com/2015/02/07/new-twists-and-turns-soap-opera-called-obamacare-159077
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The House of Representatives voted to repeal the Affordable Care Act on February 3. Then, this is not new. The House has voted nearly 60 times to either revoke the law or to make huge changes.</p></div></div></div>Sat, 07 Feb 2015 17:00:00 +0000kpolisse159077 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2015/02/07/new-twists-and-turns-soap-opera-called-obamacare-159077#commentsWhy Not Mandate Mandatory CSC Funding?http://indiancountrytodaymedianetwork.com/2014/12/28/why-not-mandate-mandatory-csc-funding
<fieldset class="field-group-fieldset group-opinions-body form-wrapper" id="node_opinion_rss_group_opinions_body"><legend><span class="fieldset-legend">Body</span></legend><div class="fieldset-wrapper"><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The time has come to fund tribal contract support costs, or “CSC,” from the mandatory federal spending accounts of the federal government, the same as are Social Security, Medicare, Medicaid, interest on the national debt, court judgments and other obligations of the United States.</p>
<p>CSC funding covers the indirect costs required to administer multiple federal contracts and grants. It is the common practice with all federal contracting, including military and higher education contracts.</p>
<p>Unlike with other federal contractors, tribes have not received full CSC funding in recent decades. As a consequence, tribes have been forced to divert tribal program funds to pay for these administrative expenses. CSC funding is what fuels tribal services, like gas in a car. You might be able to roll downhill for a while, but your car won’t get very far without it.</p>
<p>Fewer dollars for core tribal administrative functions diminishes a tribe’s ability to effectively serve its tribal citizens. The exercise of tribal sovereignty and governmental functions is like a muscle – if you don’t use it, you lose it. Without administrative funds essential to fulfilling its mission to benefit its citizens, a tribe’s sovereignty and ability to becoming self-reliant is at risk.</p>
<p>Tribal self-governance and self-reliance has done much to transform Indian country ever since the beginning of the Indian Self-Determination movement era 40 years ago. But the annual threat of funding reductions, blown by the political winds of the moment, make for a fragile future for this exercise of tribal sovereignty. Administrative funding shortfalls could turn the Indian Self-Determination and Education Assistance Act of 1975, as amended, into a house of cards and a shrine to empty promises.</p>
<p>The Act’s original idea was simple and straightforward – it makes common sense to empower tribal governments to assume the administration of federally-funded programs, functions, services and activities because tribes can run them more efficiently and effectively than can federal bureaucracies. Not only did this innovative initiative stretch the limited federal dollars available to meet need, but it allowed tribes local flexibility to target actual and current need. When you think about it, tribal political and cultural structures actually hold tribal providers far more accountable than federal workers are held by personnel rules and congressional oversight.</p>
<p>But for decades, until the tribes prevailed in federal court a few years ago, Congress and OMB shied away from paying the full contract support costs owed to tribes. Even today, the widely heralded move by Congress to fully fund CSC has come at a price – the Budget Control Act and its sequestration impact has resulted in full funding for CSC being reprogrammed from program accounts and diminished services to tribal communities.</p>
<p>The only fair and honorable answer is to pay tribal CSC costs – governed by indirect cost rates that are negotiated under common federal rules to meet actual expenses reflecting regional cost differences – from mandatory spending accounts and to hold them exempt from sequestration. Whatever is a tribe’s real administrative cost should be paid, so long as it conforms to the reasonable and necessary expenditure requirements of a negotiated federal rate. And that payment of CSC should not come at the expense of program funding accounts.</p>
<p>In our judgment, CSC fits nicely with the definition of exempt mandatory spending, which is composed of programs funded by formulas set in law and paid out of accounts with guaranteed appropriations. Such accounts include Social Security, certain health care programs, and what is known as “other mandatory spending.” It is time for the Obama Administration and the Congress to further fulfill the historical, moral and legal obligations the United States has to the 566 American Indian and Alaska Native Nations by using the FY 2016 budget reconciliation process to include tribal CSC funding within exempt “other mandatory spending.” Now that would be a legacy with real and lasting effect.</p>
<p><em>Philip Baker-Shenk was general counsel to the Senate Committee on Indian Affairs and now represents Tribes through Holland &amp; Knight, LLP. W. Ron Allen is Chairman and Chief Executive Officer of the Jamestown S’Klallam Tribe in western Washington.</em></p>
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<div class="field field-name-field-short-title field-type-text field-label-above"><div class="field-label">Short title:&nbsp;</div><div class="field-items"><div class="field-item even">Why Not Mandate Mandatory CSC Funding?</div></div></div><div class="field field-name-field-category field-type-taxonomy-term-reference field-label-above"><div class="field-label">Category:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/taxonomy/term/335" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Opinion</a></div></div></div><div class="field field-name-field-full-name field-type-text field-label-above"><div class="field-label">Full name:&nbsp;</div><div class="field-items"><div class="field-item even">Philip Baker-Shenk and W. Ron Allen</div></div></div><div class="field field-name-field-primary-category field-type-taxonomy-term-reference field-label-above"><div class="field-label">Primary category:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/taxonomy/term/335" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Opinion</a></div></div></div><div class="field field-name-field-tags field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/tags/philip-baker-shenk" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Philip Baker-Shenk</a></div><div class="field-item odd"><a href="/tags/w-ron-allen" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">W. Ron Allen</a></div><div class="field-item even"><a href="/tags/contract-support-costs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Contract Support Costs</a></div><div class="field-item odd"><a href="/tags/social-security" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Social Security</a></div><div class="field-item even"><a href="/tags/medicare" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Medicare</a></div><div class="field-item odd"><a href="/tags/medicaid" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Medicaid</a></div><div class="field-item even"><a href="/tags/national-debt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">National Debt</a></div><div class="field-item odd"><a href="/tags/indian-self-determination-and-education-assistance-act-1975" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Indian Self-Determination and Education Assistance Act of 1975</a></div><div class="field-item even"><a href="/tags/tribal-csc" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tribal CSC</a></div><div class="field-item odd"><a href="/tags/tribal-contract-support-costs" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tribal Contract Support Costs</a></div></div></div><div class="field field-name-field-author-image field-type-taxonomy-term-reference field-label-above"><div class="field-label">Author image:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/author/ictmn-logo" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ictmn logo</a></div></div></div><div class="field field-name-field-department field-type-taxonomy-term-reference field-label-above"><div class="field-label">Department:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/department/politics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Politics</a></div></div></div>Sun, 28 Dec 2014 17:16:57 +0000kpolisse158469 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/12/28/why-not-mandate-mandatory-csc-funding#commentsA Deficit Cure: Spend More Money Nowhttp://indiancountrytodaymedianetwork.com/2014/08/13/deficit-cure-spend-more-money-now-156382
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>I’ve spent the past couple of months listening to political candidates in a variety of formats. I like most of them as people, but I am struck by how thin our political discourse can be.</p></div></div></div>Wed, 13 Aug 2014 13:00:00 +0000kpolisse156382 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/08/13/deficit-cure-spend-more-money-now-156382#commentsAlaska’s First Native Governor? Meet Byron Mallotthttp://indiancountrytodaymedianetwork.com/2014/08/12/could-byron-mallott-become-americas-first-native-governor-156356
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><em>UPDATED: Third Paragraph now reflects that Mallott would be second Native U.S. Governor.</em></p>
<p>It’s Friday morning at 7 o’clock Alaska time and Byron Mallott’s on the phone, returning a reporter’s interview request. He’s been on the road and he sounds tired.</p>
<p>Mallott is pushing hard. Two weeks before the August 19 primary, a poll shows him 15 points behind incumbent Sean Parnell in the race for governor of Alaska. But, Mallott said, pollsters telephoned Alaskans who use landlines, not the cell phones used in most of rural Alaska, where Mallott is certain his strength is.</p>
<p>If Mallott's hunch is right, he could be one step closer to becoming the first Native American governor of Alaska. (It was initially believed he'd be the first Native American governor of a U.S. state. That distinction goes to Johnston Murray, Chickasaw, governor of Oklahoma in 1951-55.)</p>
<p>Mallott, Tlingit, is a youthful 71 and has been involved in politics and government for almost 50 years. He was serving as mayor of Yakutat when the current governor was getting ready for kindergarten. He went on to serve as mayor of Juneau, and direct various state agencies, commissions and statewide organizations.</p>
<p>Mallott (pronounced Mal-LOTT) was born in 1943 in his ancestral home of Yakutat. He was elected mayor at 22. In his ensuing career, he served as commissioner of the state department of Community and Regional Affairs; president of the Alaska Federation of Natives; executive director, Alaska Permanent Fund Corporation; co-chairman of the state Commission on Rural Governance and Empowerment; chairman of the Nature Conservancy of Alaska; and president, CEO and senior fellow of the First Alaskans Institute.</p>
<p>He served as a trustee of the Smithsonian Institution’s National Museum of the American Indian, member of the Alaskan Command Civilian Advisory Board; and member at large of the Institute of the North.</p>
<p>On the business side, he served as CEO, chairman and director of Sealaska Corporation; director, Alaska Communications Systems Holdings; and founding director of Alaska Commercial Fisheries and Agriculture Bank. He served on the boards of the Federal Reserve Bank of San Francisco, Native American Bancorporation Co., Native American Bank, N.A., Seafirst Bank, Alaska Air, the National Alliance of Business, and Yak-tat Kwaan, Inc., an Alaska Native corporation. He is a licensed pilot and a commercial fisherman.</p>
<p>Mallott has an honorary doctorate in humanities from the University of Alaska, was executive-in-residence at University of Alaska Southeast’s School of Business &amp; Public Administration, and was inducted into the Alaska Business Hall of Fame. He was named Alaskan of the Year in 2012 and is a recipient of the Eric Johnson Champion of Native Rights Award.</p>
<p></div></div></div>Tue, 12 Aug 2014 13:00:00 +0000kpolisse156356 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/08/12/could-byron-mallott-become-americas-first-native-governor-156356#commentsThe Billion Dollar Hard Sell: Obamacare's Slow Start in Indian Countryhttp://indiancountrytodaymedianetwork.com/2014/06/06/billion-dollar-hard-sell-obamacares-slow-start-indian-country-155172
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The Affordable Care Act—Obamacare—remains a hard sell in Indian country.</p>
<p>The <a href="https://indiancountrytodaymedianetwork.com/sites/default/files/ncai_calculator_33_state_database_2014_with_medicaid_and_marketplace_income_categories_28wi_fixed29.xlsx">first comprehensive report from government data</a> show that key measures, such as the purchase of insurance, reflect only about 3 percent of eligible American Indians and Alaska Natives buying from a marketplace exchange. The result is that more than a billion dollars in tax credits—as well as additional tens of millions of increased funding for the Indian health system—is left behind and unclaimed.</p>
<p>And nearly a million American Indians and Alaska Natives remain uninsured during the first year of this new law.</p>
<p>Still, the Affordable Care Act has the potential to radically shift the funding mechanisms for the Indian health system. The way the law is supposed to work is to give American Indian and Alaska Natives additional insurance options. This is critical because under current law, Congress appropriates $4.4 billion for Indian health and that amount is not nearly enough to fund the Indian health system. But the Affordable Care Act promotes new revenue, money from private insurance, Medicaid, Medicare and other payers, that's currently budgeted at $810 million. But even that total, $5.2 billion, is not nearly enough. The Indian Health Service estimates that its per person spending under this formula is $2,849 compared to $7,713 per person spending for the U.S. population.</p>
<p><img alt="Mark Trahant" class="media-image media-image-right" height="1034" style="width: 150px; height: 185px; float: right;" width="840" typeof="foaf:Image" src="http://d1jrw5jterzxwu.cloudfront.net/sites/default/files/default/files/uploads/mark_trahant_-_2013.jpeg" title="" />So the idea is that third-party billing from insurance will eventually eliminate the funding gap. If enough people from Indian country get insurance from all sources, there is the potential for a fully funded health system. Ideally, every patient would be educated about their insurance options (often at no cost) while they are are at a health facility.</p>
<p>But a fully funded health system remains a far off promise.</p>
<p>The Affordable Care Act has had many problems in its first form. The healthcare.gov web site did not work and there is much confusion about the available options for American Indians and Alaska Natives. Indeed, much of the early marketing for the Affordable Care Act was to educate Native Americans about the exemption from the insurance mandate instead of explaining why insurance could improve funding for the entire Indian health system.</p>
<p>RELATED: <a href="http://indiancountrytodaymedianetwork.com/2014/03/27/affordable-care-act-ought-be-transparent-whats-working-154173">The Affordable Care Act Ought to Be Transparent; What’s Working?</a></p>
<p>The Affordable Care Act sets out to increase funding for Indian health programs in three ways: Expand Medicaid eligibility; help people purchase insurance (called Qualified Health Plans) on their own; and add new insurance requirements for employers.</p>
<p>“IHS has estimated that the greatest impact for our patients is likely to be the Medicaid expansion and we estimate much greater potential for third party collections through Medicaid enrollment,” according to Raho Ortiz, IHS’ director of the business office enhancement. “In the FY 2014 President's Budget Request, IHS estimated collections from private insurance due to the Affordable Care Act to increase by $5 million, and collections due to the Medicaid expansion to increase by $95 million if all states adopted the expansion.”</p>
<p>That’s where the political debate about the Affordable Care Act is impacting the budget because so many states have opted out for political reasons. Alaska, Oklahoma, Montana and South Dakota are among the states that rejected the Medicaid expansion. Of the nearly one million uninsured American Indians and Alaska Natives, more than 460,000 live in states without Medicaid expansion. Thus, Ortiz said, the “estimates for Medicaid collections would be lower.”</p>
<p>Next year’s IHS budget estimates that collections from private insurance may not change, but the potential increase from Medicaid collections is $22 million. “Many of our patients are finding when they enroll in the marketplace that they are newly eligible for Medicaid in those states that have implemented the Medicaid expansion and therefore do not need to purchase insurance,” he wrote in an email.</p>
<p>Ed Fox, director of Health Services for the Port Gamble S’Klallam Tribe of Washington, compiled national data for his website, Health Care Reform for American Indians and Alaska Natives.</p>
</div></div></div>Fri, 06 Jun 2014 12:30:00 +0000klb678155172 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/06/06/billion-dollar-hard-sell-obamacares-slow-start-indian-country-155172#commentsThe Affordable Care Act Ought to Be Transparent; What’s Working?http://indiancountrytodaymedianetwork.com/2014/03/27/affordable-care-act-ought-be-transparent-whats-working-154173
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The Affordable Care Act is a grand promise. Basically it’s a complicated insurance mechanism that’s designed to reduce the number of uninsured Americans, including those who rely on the <a href="http://www.ihs.gov/aca/thingstoknow/" target="_blank">Indian health system</a>.</p>
<p>But one thing the ACA is not: Transparent.</p>
<p>This is a critical flaw because we are near another major deadline — March 31 — and some six months into the Act’s implementation and there is not one official scrap of information reporting how well Indian country is being served. We don’t know how many folks across the country have signed up for Medicaid or how many have purchased insurance or how many individuals have policies that were purchased by tribes as sponsors.</p>
<p>Why does this matter? Because policy is being implemented on assumptions, not data. We don’t know what we don’t know.<img alt="Mark Trahant" class="media-image media-image-right" style="line-height: 1.6em; width: 200px; height: 246px; margin: 2px; float: right;" typeof="foaf:Image" src="http://d1jrw5jterzxwu.cloudfront.net/sites/default/files/default/files/uploads/mark_trahant_-_2013_0.jpeg" title="" /></p>
<p>This we do know: March 31 is an odd deadline. It’s the day when open enrollment ends for most Americans, including Native Americans who are not tribal members. But that deadline does not apply to American Indians and Alaska Natives who are tribal members. Then a monthly enrollment is possible. (I know, confusing, right?)</p>
<p>Native Americans still can receive a lifetime exemption from the insurance mandate. <a href="http://marketplace.cms.gov/getofficialresources/publications-and-articles/tribal-exemption.pdf" target="_blank">Fill out a simple form</a> and mail to get a certificate that could be included in your next tax return.</p>
<p>But we also know that the individual exemption is not enough. The Indian health system is underfunded and third-party billing — money from private insurance, Medicaid, Medicare, and other programs — is the only way funding will improve. Like it or not, <a href="https://www.youtube.com/watch?v=fQQKPH0_wPw" target="_blank">Treaty or not,</a> the Congress is not going to pay for Indian health through appropriations. <a href="http://www.ihs.gov/newsroom/includes/themes/newihstheme/display_objects/documents/IHS_FY2015_PresidentsBudgetRequestSlides.pdf" target="_blank">The $6 billion budget</a> for the Indian Health Service shows the agency collecting more than a billion dollars from Medicaid and only $90,307,000 from private insurance. So there is a lot of room for growth. Again, if folks sign up, the Affordable Care Act is a different course from appropriations; it’s a money stream that’s automatic.</p>
<p>We also know that Indian country has some of the highest uninsured rates in the nation, <a href="http://kff.org/disparities-policy/issue-brief/health-coverage-and-care-for-american-indians-and-alaska-natives/" target="_blank">roughly one in three people.</a> So every new insured American Indian and Alaska Native adds resources to the Indian health system (and especially medical care that is purchased outside of Indian health facilities).</p>
<p>This week there is a last minute push to get people in Indian country to sign up. On Monday there was a national Tribal <a href="http://www.whitehouse.gov/blog/2014/03/21/join-us-march-24th-tribal-day-action-affordable-care-" target="_blank">Day of Action</a> sponsored by the White House. And in Montana, the state’s Insurance Commissioner, <a href="http://www.kxlo-klcm.com/site/index.php?option=com_content&amp;view=article&amp;id=2662:lindeen-reminds-national-health-insurance-open-enrollment-period-ends-march-31&amp;catid=10:news-pod&amp;Itemid=114" target="_blank">Monica J. Lindeen,</a> has been traveling to the state’s reservations and urban Indian centers to sell the plan.</p>
<p>But it’s hard to know how well those efforts are working. There are too many questions: How many people signed up early? What’s the goal? Where is the transparency?</p>
<p>Early Affordable Care Act numbers are found in Washington state. Ed Fox, who directs health services for Port Gamble S’Klallam Tribe of Washington, said the Washington Health Care Authority released preliminary figures to tribes for consultation. These are early numbers and will change, but they are an open important look in a state where the Affordable Care Act is working.</p>
<p></div></div></div>Thu, 27 Mar 2014 18:00:00 +0000kpolisse154173 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/03/27/affordable-care-act-ought-be-transparent-whats-working-154173#commentsTribal Citizens Not Exempt by Default—Fill Out Form to Avoid Tax Liability!http://indiancountrytodaymedianetwork.com/2014/01/17/tribal-citizens-not-exempt-default-fill-out-form-avoid-tax-liability-153154
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>According to the Affordable Healthcare Act, there are nine exemptions from a citizen required to carry the minimal essential coverage of Health Insurance.</p></div></div></div>Fri, 17 Jan 2014 19:14:14 +0000klb678153154 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/01/17/tribal-citizens-not-exempt-default-fill-out-form-avoid-tax-liability-153154#commentsCongress and the Budget of Mehhttp://indiancountrytodaymedianetwork.com/2014/01/15/congress-and-budget-meh-153119
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>The adjective of the day is “modest.” That’s the standard phrase to describe the <a href="http://appropriations.house.gov/news/documentsingle.aspx?DocumentID=366712" target="_blank">$1.012 trillion spending bill </a>for a federal fiscal year that </p></div></div></div>Wed, 15 Jan 2014 19:00:00 +0000kpolisse153119 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2014/01/15/congress-and-budget-meh-153119#commentsA Deadline Whizzes By and Indian Health Money Is Left Behindhttp://indiancountrytodaymedianetwork.com/2013/12/23/deadline-whizzes-and-indian-health-money-left-behind-152843
<div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Monday was a key <a href="https://www.healthcare.gov/timeline-of-the-health-care-law/" target="_blank">deadline for the Affordable Care Act.</a> In order to begin insurance coverage on January 1, 2014, people were supposed to sign up by December 2</p></div></div></div>Tue, 24 Dec 2013 00:00:00 +0000kpolisse152843 at http://indiancountrytodaymedianetwork.comhttp://indiancountrytodaymedianetwork.com/2013/12/23/deadline-whizzes-and-indian-health-money-left-behind-152843#comments